Due to continued high demand, APTA will host a third Q&A call for members to answer questions about functional limitation reporting requirements. The next call-in will be Tuesday, July 23, 2:00 pm-3:00 pm (ET). Participants will need access to a computer and the Internet. Space is limited, so secure your spot soon. To register please e-mail advocacy@apta.org with "July 23 Call" in the subject line.

All providers who bill outpatient therapy services under Medicare Part B must submit functional limitation data (G-codes and appropriate modifiers) for any Medicare beneficiary, or claims will be returned unpaid. Therapists must report functional limitation data on the beneficiaries' current functional status and on the projected goal at scheduled intervals throughout the episode of care, including at the outset of the therapy episode, no less frequently than every 10th visit, and at discharge.

Comments

If you are re-evaluating a patient on the 7th visit, does the 10 visit count start over at that point?? Or do you have to note the Gcodes again 3 days after the re-evaluation?

Posted by Irene Cote -> @O
on 7/23/2013 8:06 AM

If a patient does not return to therapy can discharge g codes be sent if the last visit was billed already?

Posted by Gail Bock frankel
on 7/23/2013 11:37 PM

We are constantly having problems with Medicare splitting the claims and putting the G-codes on a separate claim and then denying the claims. When we call them they think we are splitting them when is clearly states in the explanation part of the EOB that it is being split by them. Then they tell us it is because we are submitting it incorrectly. But when they investigate it, they find that we are not doing it wrong. In the meantime, they are holding up payment on numerous accounts. This is frustrating and wish they would get it fixed.